Archive for the ‘Malnutrition’ Category
Infographic: Malnutrition Worldwide
Friday, September 16th, 2011Press Release: Child Mortality Observed 50% Lower With Better Food
Tuesday, May 24th, 2011PARIS/NIAMEY, May 24, 2011 – Mortality rates were observed to be 50 percent lower among a large group of young children in the west African nation of Niger in 2010, after they received a highly nutritious supplemental food, according to preliminary findings in a study by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF).
The encouraging findings reinforce the need for international donors and policymakers to make high-quality foods a cornerstone of childhood health programs, especially in areas where malnutrition is rife.
Malnutrition weakens the immune system, exposing a child to higher risk of death from other illnesses, such as malaria, respiratory infections, and diarrhea. Adding a quality supplemental food to an essential package of care—including vaccination and effective treatment and prevention of primary ‘killer diseases’ of young children—will accelerate the fight against child mortality.
Last year in Muskoka, Canada, G8 member states committed to refocus efforts over the next five years to cut mortality rates of children under five years of age, by two-thirds from 1990 levels. At their meeting this week in Deauville, France, G8 members should commit to ensure that appropriate foods reach vulnerable children, MSF said.
“Our preventive strategies focused on getting a nutritionally appropriate food to children during the most crucial time—the critical window of six months to two years of age—instead of waiting for them to start losing weight, and we observed child mortality rates to be lower by half,” said Dr. Isabelle Defourny, MSF program manager for Niger. “If donors and policymakers are serious about reducing child mortality rates, then providing child-appropriate foods must be made a standard component of any pediatric program in the world’s ‘malnutrition hotspots’.”
At any given time, an estimated 195 million children are affected by malnutrition worldwide. It contributes to at least one-third of the eight million annual deaths of children less than five years of age.
For several years, MSF has been developing preventive approaches to malnutrition—based on quality supplementary foods—in order to lower the burden of deaths in ‘malnutrition hotspots’ such as in the Sahel region of Africa. The Sahel features child mortality rates among the highest in the world. During a severe food and nutrition crisis in 2010 in the Sahelian country of Niger, local authorities, together with MSF and the Nigerien organization FORSANI (Forum Santé Niger), implemented the largest-ever distribution of supplemental foods designed to prevent malnutrition in young children.
Between July and December, 2010, three-to-six-month supplies of a ready-to-use paste rich in milk, minerals, and vitamins were distributed to approximately 150,000 children—most between 6 months and 2 years-of-age—in five districts of the Tahoua, Maradi, and Zinder regions. Some of the children also benefitted from protection rations (mainly cereals and fortified flours) provided by WFP. Pediatric healthcare for common childhood illnesses, such as malaria, and acute malnutrition, was also available in the distribution areas, including for the children who did not receive a nutritional supplement.
Epicentre, MSF’s epidemiology branch, conducted monthly surveys among a cohort of several thousand young children living in the distribution zones. All benefitted from monitoring for signs of malnutrition and illness. Children requiring medical care were referred to MSF and its partners working within Nigerien health-care facilities.
The mortality rate was seen to be more than 50 percent lower among those who received the foods tailored specifically to the nutritional requirements of young, growing children.
In the Madarounfa district in Maradi region, the observed mortality rate among children who received the enriched foods was 2.2 deaths per 10,000 children per day, compared to 5.3 deaths per 10,000 children per day among those who did not receive supplements. In the Guidan Roumji district of Maradi, mortality rates were 1.1 per 10,000 per day compared to 2.5 per 10,000 per day. In the town of Mirriah in Zinder region, the rates were 1.2 per 10,000 per day versus 3.2 per 10,000 per day.
“Providing young children with high quality nutritious foods has long been one of the foundational principles of successful malnutrition and child mortality reduction programs in Europe, Latin America and the United States, along with immunization, for instance,” said Dr. Susan Shepherd, MSF child nutrition advisor. “It’s time to stop applying different standards for children living in malnutrition hotspots. We can save children’s lives today if the appropriate resources are put behind similar interventions to those we deployed last year in Niger.”
Countries such as Mexico, Thailand, the United States, and many European nations, have successfully reduced early childhood malnutrition and mortality through programs that ensure infants and young children from even the poorest families have access to nutritious foods, such as milk and eggs. However, many food-insecure families cannot afford these animal-sourced foods, which contain the high-quality proteins, fats, and other essential nutrients that children require. National programs that fill this nutritional gap for young children are essential.
The development in recent years of a new generation of nutritional foods tailored to the needs of the most vulnerable children, which are simple to use, make possible the establishment of a new standard in childhood mortality prevention.
In 2010, in addition to malnutrition prevention activities, MSF and its partners, FORSANI and BEFEN / ALIMA, carried out pediatric and nutritional activities in 64 primary care facilities and nine hospitals in Niger’s Tahoua, Maradi and Zinder regions. Approximately 150,000 children suffering from malnutrition were treated—nearly half of all the malnourished children treated in the country in 2010—of whom approximately 24,000 were hospitalized. Between 85 and 92 percent of children were discharged. MSF and its partners also treated 216,330 cases of malaria among children less than five years of age, conducted more than 370,000 pediatric consultations, and admitted more than 13,000 children to hospital.
IRIN News: Getting the Recipe Right
Friday, May 13th, 2011AID POLICY: Getting the recipe right for US food aid
© Antonin Kratochvil/VII
JOHANNESBURG, 13 May 2011 (IRIN) – Changing the food the US government supplies as aid could deliver better results and still save money, a new study says. The review for the US Agency for International Development (USAID) by researchers at the Tufts University Friedman School of Nutrition Science and Policy has been welcomed by NGOs and US food aid experts, but the findings have also come in for some criticism.
The two-year review considered if USAID food aid was up to date with current science, especially in its use of blended food and whether programmes matched the right products with expected outcomes.
“What we’re recommending is approaches to enhance the many great things already being done with US food aid under the most difficult circumstances imaginable,” Amelia Reese Masterson, research coordinator of the review, wrote to IRIN, referring in part to USAID’s budget pressures.
The review came up with 20 recommendations on some of the food products and programmes under Title II of the US Food for Peace Act, which covers food aid provided in emergency and non-emergency situations.
Getting the ingredients right
The Tufts review addressed the issue of the source of protein in food products for children, pregnant and lactating women, and undernourished people on HIV medication.
Médecins Sans Frontières (MSF) has noted that US food aid destined for children usually comprises fortified flours based on grains and pulses such as corn-soya blend (CSB) or wheat-soy blend (WSB) and has lobbied for the inclusion of other sources of protein, vitamins and minerals.
Recent scientific evidence shows that animal-source proteins such as milk, better promote the growth of muscle tissue and resistance to infections, and are critical to children recovering from severe malnutrition, the Tufts review agreed. It also acknowledged that ready-to-use therapeutic foods (RUTF), usually lipid-based spreads, whose ingredients typically include nuts and milk powder, have led to a radical change in the way severe malnutrition is treated.
The review recommended that a wider range of products, offering varying quantities and types of nutrients for different programmatic contexts, be made available.
It is here that the review has contradicted itself, Nathalie Ernoult, Stephane Doyon and Susan Shepherd, members of the MSF’s nutrition team, maintained in a written submission to the Tufts academics.
A la carte or menu fixe?
“The report itself states that there can be no ‘one-size-fits-all’ food supplement, and we could not agree more,” the MSF team said, yet it “focuses primarily on how to improve the nutritional value of fortified blended flours.”
The Tufts study argued for a single formulation for a cost-effective, enhanced CSB, which they dubbed CSB14, to meet the minimum nutritional requirements of three key target groups: infants from 6 to 11 months; children between one and three years; and pregnant women.
The MSF team said at least two enhanced CSB formulations would be necessary: one tailored to the needs of infants and young children and those affected by moderate acute malnutrition; the other for older children and adults.
UN organizations the World Food Programme (WFP) and the UN Children’s Fund (UNICEF) are also considering experimenting with different formulations of CSB.
“As a field-level agency and occasional implementing partner for UNICEF and WFP, we [MSF] cannot over-emphasize the need for coherence in the nutritional supplements on offer for a given category of beneficiary,” the MSF team said. “If the fortified foods provided by WFP, UNICEF and USAID for similar programmes are not interchangeable, nutrition programmes will simply become confused and ineffective.”
MSF maintained that the formulation for younger children should have a higher protein content from animal-sourced food; and that the proposed fortification levels of iron and zinc were also too low.
Zita Weise Prinzo of the World Health Organization (WHO) said they were recommending that the diets of moderately malnourished children contain animal-sourced foods, without specifying how much. WHO is expected to release its guidelines for food formulations for moderately malnourished children in June 2011.
According to MSF, the proposed second formulation for older children and adults, would not require animal-sourced ingredients, and the current CSB recipe, with some adjustments to its vitamin and mineral content, would serve the purpose.
However, a senior nutritionist who preferred not be named told IRIN that in many instances it would be hard to imagine relief agencies successfully distributing two or more similar looking products for different segments even within a single family.
“Most large-scale programmes using CSB-type products involve take-home rations. It would be difficult for a programme to ensure the proper use of several similar products at home. The solution could be to have one ‘generic’ option used by most big programmes, similar to that proposed by the [Tufts] paper, and then several other options that would be used by ‘speciality’ programmes.”
The CSB14 formulation depends on the addition of oil fortified with vitamin A to provide enough of the vitamin. “Our experience shows that it is difficult to count on the prescribed amounts of oil being added to the porridge in the home, not to mention all the logistical difficulties encountered with the distribution of multiple commodities to constitute a single ration,” the MSF team pointed out.
The chemical forms of micronutrient supplements proposed by Tufts also differed from those on the list approved by the WFP, the biggest dispenser of US aid. “It is very important to come to common agreement on a list of acceptable chemical forms for all additives,” the MSF team noted.
PEPFAR food
Programming should “be evidence-based, not driven by simple data on tonnages and ‘hungry people fed’, but by an understanding of the unit cost of impact,” and this included HIV/AIDS-related programmes, said the review. It found that orphans and vulnerable children, and HIV-positive pregnant and lactating women, identified for priority food assistance in the US President’s Emergency Plan for AIDS Relief (PEPFAR), were receiving not getting priority compared to other HIV-positive women and adults.
The review suggested stronger links between ongoing antenatal, Prevention of Mother-to-Child Transmission (PMTCT), and Maternal and Child Health (MCH) services, and with programmes treating malnourished children.
PEPFAR country coordinators reported that requests to approve the use of funds for food were “commonly met with caution”, the review said, which “contributes to low coverage of food assistance within programmes”, and PEPFAR needed to send a stronger signal on supporting the allocation of funds to food in HIV support.
Saving money
Budget-constrained donors were “facing hard trade-offs between feeding as many people as possible and providing higher quality foods to improve nutritional impact per person,” said Christopher Barrett, a food aid expert who teaches development economics at Cornell University in the US.
Scarce resources should be put to work more efficiently, and the Tufts review contributed significantly to improving understanding of these tradeoffs by policymakers, operational agencies and commercial suppliers, Barrett commented.
“It’s important to move beyond a dollar-per-ton of food metric – the conventional way of looking at things – since that does not take into account exactly what kinds of foods are used for what purposes,” said Patrick Webb, principal investigator of the Tufts review project.
“If we become more efficient in treating or preventing malnutrition, then it’s the cost per case of malnutrition treated or prevented that matters, and that will go down when the appropriate tools (foods) are used in the right ways, even if unit costs of products rise slightly… because less is needed (over a shorter period of treatment).”
Some of the Tufts recommendations would cost more money – the addition of dairy products, new smaller packaging of some products for mothers and infants to prevent it from being consumed by the entire family – but Webb said the costs would be offset by improved targeting of the enhanced products.
Barrett noted that “With greater bang for the buck, it also becomes easier to defend valuable food aid programmes against those looking to trim budgets.”
The review, the issues it covers and its recommendations will be debated at the US government’s annual conference on food aid in June.
VOA Article Focuses on Efforts to Prevent Malnutrition in Niger
Monday, January 31st, 2011MSF is one of several aid organizations advocating for the preventative treatment of malnutrition for children in Niger. Adding nutrient-rich food supplements to a regular diet provides vulnerable children with the protein and vitamins their bodies need to grow and develop.
In Niger, where food shortages are common, children often lack these essential dietary needs. As Patrick Barbier, head of MSF’s Niger mission explains, “There is a clear link between access to healthcare and acute malnutrition being a disease and not only a deficiency of food. Access to health care is poor, so the health status of the children is poor.”
Read the full article from Voice of America News and learn more about MSF’s research on preventative malnutrition in a recent article in the medical journal Pediatrics.
Women wait in a food distribution line at a health clinic in the Maradi region of Niger. © Yann Libessart / MSF
Brookings Institution Hosts Panel Discussion on Childhood Malnutrition
Monday, October 18th, 2010On October 12th, MSF and the Wolfensohn Center for Development at the Brookings Institution hosted a discussion of the challenges in global food assistance and how recent developments and initiatives can be expanded to effectively tackle the ongoing crisis of global child malnutrition.
Panelists included MSF’s Nutrition Coordinator Dr. Susan Shepherd; Bruce Cogill, chief of nutrition at USAID; Meera Shekar, lead health and nutrition specialist at the World Bank; and Victoria Quinn, senior vice president for progams, Helen Keller International. Elaine Wolfensohn, founder of the Wolfensohn Family Foundation, made introductory remarks. Brookings Nonresident Senior Fellow Raj Desai moderated the discussion.
Watch the discussion and Q & A here:
(from L to R) Victoria Quinn, Susan Shepherd, Raj Desai, Bruce Cogill, and Meera Shekar
Susan Shepherd described MSF's efforts to treat malnourished children in the Sahel region of Africa.
Meera Shekar, lead nutrition specialist at the World Bank, told the Brookings audience that greater collaboration among donors would make the fight against malnutrition more effective.
Breaking the Vicious Circle of Malnutrition in Niger
Friday, October 1st, 2010Niger: Treatment and Prevention to Break the Cycle of Malnutrition
Wednesday, September 8th, 2010
A mother receives ready-to-use therapeutic food for her child in Madarounfa during an MSF nutrition distribution. © Anthony Bourasseau/MSF
Niamey, September 8, 2010 — Every year, the population of Niger is affected by a nutritional crisis that peaks between May and September. The scale of the crisis in 2010 is particularly worrying.
More than 77,000 children with severe malnutrition have already been treated this year in the 69 nutritional centers supported by Doctors Without Borders/Médecins Sans Frontières(MSF) and its partners: Forum Santé Niger (FORSANI), and Bien-Être de la Femme et de l’Enfant au Niger (BEFEN/ALIMA). Since July, MSF has also been distributing food supplements to more than 143,000 young children to prevent them from becoming malnourished. Quality preventive measures are crucial in dealing with the recurrent nutritional crisis in Niger.
“With the overwhelming number of severely malnourished children in need of treatment, the medical structures run by the Ministry of Health become overburdened,” said Patrick Barbier, MSF’s head of mission in Niger. “Those children are often in a critical health condition, which increases the risk of death. Even in the most optimistic scenario, mortality rates in nutritional programs are still high, ranging from three to four percent. This is why preventing malnutrition is also crucial.”
In addition to providing treatment for children with severe malnutrition, MSF is distributing ready-to-use supplementary food to more than 143,000 children. These products, containing milk, minerals, and vitamins, are adapted to the nutritional needs of young children. The plan has been worked out with the Government of Niger, the World Food Program (WFP) and UNICEF and the distributions are being implemented in five districts in collaboration with Nigerien organizations.
“Prevention is about finding the best way of stopping children from becoming severely malnourished year after year,” said Dr. Susan Shepherd, coordinator of MSF’s nutritional working group, “decreasing the medical, logistical, and financial burdens that are created by the treatment of so many sick children.”
The distribution of food supplements on a large scale this year represents a major positive change in the preventive response to the nutritional emergencies in Niger. However, the recurrent nature of the nutritional crisis in the country calls for these preventive strategies to be integrated into the fight against malnutrition on a more permanent basis.
MSF aims to work with its local and international partners to define the best product and the most effective long-term strategy to prevent malnutrition among young children in Niger.
MSF and its national partners BEFEN/ALIMA and FORSANI have admitted more than 77,000 children with severe malnutrition out of the 170,000 who received care in the country since the beginning of the year. In these regions, as well as in Agadez, MSF provides free medical care for young children in primary health care centers and pediatric hospitals.
Podcast: How the International Food Aid System Fails Children
Tuesday, September 7th, 2010
© Antonin Kratochvil/VII
The latest MSF Frontline Reports podcast examines the development of the staple product of international food aid – corn-soy blend (CSB) - and its lack of nutritional value. MSF Nutrition Coordinator Dr. Susan Shepherd and Communications Director Jason Cone discuss corn-soy blend, the development of nutrient-rich alternatives, and the most effective ways to treat malnutrition.
Podcast: Malnutrition Crisis in Chad
Tuesday, August 31st, 2010
An MSF staff member measures a child's mid-upper arm circumference at a nutrition program in the Guéra region. © Boris Revollo / MSF
MSF is conducting emergency nutrition interventions in Chad, in the Sahel region, where approximately 10 million people are expected to suffer from food insecurity. Hear more from the latest MSF Frontline Reports Podcast.
Dr. Susan Shepherd Discusses Malnutrition in Niger on BBC Radio’s World Today
Wednesday, August 18th, 2010Recent flooding in Niger has drastically affected food supply, increasing the country’s already-high rate of childhood malnutrition.
MSF’s nutritional centers expect to treat close to 150,000 Nigerien children this year. Listen to MSF’s Dr. Susan Shepherd discuss malnutrition in Niger on BBC’s World Service radio program, “World Today”.
Despite the current spike in malnutrition, Dr. Shepherd says, “We know that every year is a bad year for the young children in Niger when it comes to malnutrition;” what is needed are “ways to avoid having to develop last-minute, chaotic, huge, and very expensive emergency programming.”